Texas Lawmakers Study Regulations on Surprise Medical Bills

AUSTIN – Even though they may have health insurance, growing numbers of Texas consumers are getting unexpected bills from doctors not in the consumers’ health care network.

A public policy group told state legislators recently that consumers need more protection from surprise medical bills, particularly those arising from emergency room visits.

Stacey Pogue, a senior policy analyst with the Center for Public Policy Priorities, told members of the state House Insurance Committee that unexpected bills can turn a medical emergency into a financial catastrophe.

“It is very common that a consumer will get an out-of-network emergency service even if they go to an in-network hospital,” says Pogue. “We have a lot of hospitals in this state that contract with an insurance company but have not one single ER physician under that roof that takes that same insurance.”

Pogue says consumers can’t choose which doctor treats them in an emergency room, and often have no choice in which hospital an ambulance takes them.

She says patients are at their most vulnerable during medical emergencies and should not face a financial emergency later because of a surprise bill.

Pogue told legislators that they should protect consumers by eliminating surprise bills from emergencies, eliminating bills from out-of-network doctors that patients do not choose, and improving and expanding the mediation system for out-of-network bills. She says consumers are losing out under the current billing system.

“There’s fewer people protected because we put the onus on the consumer,” says Pogue. “I think that might work well for providers and insurers who go to mediation less, but I don’t think it works well for consumers. And the other thing is I think we end up giving the least help to the consumers who need it the most.”

Pogue says at least nine other states have banned surprise bills in emergencies. The Texas Legislature is expected to tackle medical billing issues during its 2017 session.